Patient and provider priorities for cancer prevention and control: a qualitative study in Mid-Atlantic Latinos

This study examines the cancer prevention and control priorities of uninsured Latin Americans and their primary care providers in metropolitan Washington, D.C. Patient and provider priorities are compared to identify common ground for future interventions in resource constrained primary care settings.

Ten focus groups were conducted among 88 Latin-American patients from 5 primary care clinics. Key informant interviews and a priority setting exercise were conducted among the clinicians and medical directors at these same clinics. Prompted by semi-structured open-ended questions, the key informant interviews and focus groups elicited patient and provider concerns and priorities for cancer prevention and control. All focus group sessions and key informant interviews were audiotaped, transcribed verbatim, and coded independently by 2 reviewers. Interrater reliability for the overall coding of distinct units of text into one of 4 major content areas was excellent, (Kappa = 0.95; 95% CI 0.94, 0.98).

All comments from the patient focus groups and provider key informant interviews fell into one of 4 content areas: cancer knowledge, attitudes and beliefs, patient socioeconomic concerns, and clinic capabilities to provide services. The most frequently mentioned theme among patients was their own lack of knowledge about cancer screening, particularly about colorectal cancer screening. Other leading patient priorities were the perceived costs of screening tests and the resource constraints of the primary care clinics serving the uninsured. Leading attitudinal concerns about screening were fatalism, embarrassment about the screening test, and non-concordant clinician gender. The leading priorities among clinicians were increasing patient knowledge about screening tests, time limitations of the clinical encounter, and primary care clinic resource constraints. The areas of greatest overlap in priorities between patients and providers were the themes of low patient knowledge about cancer screening and prevention, and recognition of the resource constraints under which these "safety net" clinics operate.

Patient knowledge level about screening, particularly colorectal cancer screening, and the impact of clinical resource constraints on the delivery of cancer screening are common priorities of uninsured Latino patients and their primary care clinicians. Stepping up efforts to improve cancer screening and prevention for Latinos requires an initial investment in developing the basic clinical infrastructure (ie, clinic capacity) of sites serving this special population. Common priorities identified from patient and provider data should be used to design evidence-based cancer prevention and control interventions within the resource limitations of the primary care settings serving the uninsured.